Table 17 The use of DESH on MRI and CT for prediction of shunt response in iNPH
Study | Sample size | Radiological methodology | Cutoff specification | Image specification | Image plane | Main reported outcomes |
|---|---|---|---|---|---|---|
Shinoda et al. [51] | n = 55 | •DESH ventriculomegaly, dilated sylvian fissures, tight high convexity, acute callosal angle, and focal sulcal dilation. Combined to form DESH score | •N/A | •MRI (no other information given) | •Transverse: EI, Tight high convexity •Coronal: Fissure Dilatation –Tight High Convexity, acute callosal angle | •Inverse correlation between the DESH score and the rate of change in the mRS score post shunting (r = -0.749) Shunt responders had higher pre-operative DESH score (6.50 ± 2.0 vs 3.94 [SNR] ± 1.5; p < 0.001) •Secondary outcomes: For INPHGS improvement: DESH score 6.39 ± 1.76 vs 4.26 ± 1.69; p < 0.001), for MMSE (DESH score 6.63 ± 1.82 vs 5.09 ± 1.93; p = 0.010), for TMT-A (DESH score 6.32 ± 1.97 vs 5.13 ± 1.93; p = 0.042), and for TUG-t (DESH score 6.48 ± 1.81 vs 4.33 ± 1.59; p < 0.001) |
Virhammar et al. [60] | n = 108 | •DESH present if narrow sulci at high convexity and Sylvian fissure ordinal were graded ≥ 1 | •N/A | •T2 Flair, T1-weighted MRI. (9% of patients on 3 T scanner; 70% on a 1.5 T scanner, 14% on a 1 T scanner and 7% on a 0.5 T scanner | •Transverse and coronal plane | •Normal Sylvian fissures was associated with greater: mRS results (p = 0.01), balance scale (P = 0.01), 10 m walk, and the walking backward test (p = 0.05) compared with dilated Sylvian fissures •OR for DESH and its components: Narrow sulci 1.43 [(0.83–2.46) p = 0.2]. Ordinal sylvian fissure 1.35 [(0.57–3.21) p = 0.5]. DESH: 2.78[(1.09–7.061, p = 0.032] |
Garcia-Armengol et al. [14] | n = 89 | •DESH present if disproportionate enlargement the inferior subarachnoid spaces and tight high-convexity subarachnoid spaces | •N/A | •MRI: spin-echo T1-weighted | •Coronal perpendicular to the anterior commissure | •SR patients were significantly more likely to have DESH than SNR (79.7% vs 20%, p < 0.001) •Sensitivity: 0.794, specificity: 0.808, PPV: 0.909, NPV: 0.618. positive likelihood ratio: 3.98, negative likelihood ratio: 0.25 and Youden index 0.60 •TP:51, TN:20 FP:13, FN:5 |
Hong et al. [20] | n = 31 | •narrowing of high cortical convexity sulci despite the widened Sylvian fissure | •N/A | •3.0 Tesla MRI scanner was used to gain Axial fluid-attenuated inversion recovery (FLAIR), T2- weighted images, T1-weighted images, and coronal T1-weighted images | •Coronal section | •Positive DESH finding in 13/14 SR and 6/12 SNR (p = 0.026) •Univariate analysis: DESH positivity had OR of 15.167 [(1.509–152.461 95% CI) p = 0.021]. On multivariate logistic regression analysis: DESH positivity had OR of 6.500 [(0.460–91.924 95% CI), p = 0.166)] |
Agerskov et al. [2] | n = 168 | •Ordinal rating 1 or 2 in Sylvian fissure dilation with obliterated sulci at the high convexity | •N/A | •MRI 1.5 T. The imaging protocol: 1) a sagittal T1-weighted volume sequence, 2) a trans axial FLAIR sequence, 3) a flow-sensitive sagittal TSE sequence, 4) an aqueduct-centered turbo field echo sequence | •Transverse and coronal images | •There was no difference in DESH findings between SR (present in 36%) and SNR (present in 34%) and it could not be used to predict SR in multivariate logistical analysis •TP:42, TN:35, FP:18, TN:73 •Its non-significant correlation coefficient with the composite score was 0.11 |
Grahnke et al. [16] | n = 72 | •N/A | •N/A | •CT or MRI | •N/A | •No significant difference found between SR and SNR. DESH pattern found in 9 SR (20%) and in 7 SNR (26%) p = 0.55 •OR 19.250; 95% CI: 1.768–209.546; p = 0.015 |